Labor and delivery can feel like a whirlwind. Even with a detailed birth plan, not everything unfolds as expected. While many parents focus on labor itself, fewer know what typically happens after birth, including the routine use of medications like Pitocin in the immediate postpartum period.
Whether you give birth vaginally or by Cesarean section, the placenta must be delivered after your baby is born. Pitocin is often given shortly after birth or after the placenta is delivered to help the uterus contract and reduce the risk of excessive bleeding.15,16 Understanding what Pitocin is, why it’s used, and whether you have a choice can help you feel more informed during this stage of care.
What Is Pitocin?
Pitocin is a synthetic hormone that mimics oxytocin, a naturally occurring hormone involved in labor, birth, and breastfeeding.¹ Oxytocin also plays a role in bonding, stress reduction, mood regulation, and lactation.1
Natural oxytocin supports healthy maternal behaviors and the breastfeeding relationship. However, the effects of synthetic oxytocin, or Pitocin, are not as well understood.2
Both natural oxytocin and Pitocin are uterotonics, meaning they cause the uterus to contract. During labor and delivery, these contractions help expel the baby and the placenta. More specifically, these hormones stimulate rhythmic contractions at the top of the uterus, which also reduces blood flow to the uterus.3,4
Related: The Benefits and Risks of Pitocin: What You Should Know
Why Is Pitocin Given After Birth?
Doctors often give Pitocin once a baby’s head and shoulders are delivered, though it may also be administered after the baby or placenta is fully delivered. Pitocin is given to help prevent postpartum hemorrhage, or excessive blood loss after delivery. Postpartum hemorrhage occurs in up to 18 percent of deliveries, and the most common cause is uterine atony. Uterine atony occurs when the uterus does not contract effectively after delivery, which can lead to excessive bleeding.5,6
Because Pitocin causes uterine contractions, providers may administer it before placental delivery to help prevent postpartum hemorrhage. It can also aid placental detachment and delivery, reducing the likelihood that the placenta will need to be removed manually. When Pitocin is given prophylactically, this approach is known as active management of the third stage of labor. This practice has been shown to reduce the risk of postpartum hemorrhage by about 60 percent.7
Related: Understanding Postpartum Hemorrhage and How To Recover
How Do Doctors Administer Pitocin After Birth?
Doctors can administer Pitocin through an intramuscular injection, like a shot, or through an IV. One large study showed significantly less blood loss when Pitocin was administered through an IV. Women who received Pitocin through an IV instead of a shot were also considerably less likely to need manual removal of their placenta.8
Pitocin Side Effects and Risks
Like any medication, Pitocin has potential side effects, though not everyone experiences them.
Water Intoxication
Large doses of Pitocin over long periods can cause water toxicity because the medication causes you to retain water by decreasing your urine output.4,9
Blood Pressure Changes
Pitocin can cause low blood pressure, particularly when given a large IV dose at one time and after a C-section. Pitocin can sometimes have the opposite effect and cause hypertension or high blood pressure.4,10,11
Nausea and Vomiting
Pitocin may cause an upset stomach and can lead to vomiting.9
Postpartum Depression
One study showed an association between Pitocin administration during labor and delivery and increased postpartum depression symptoms. However, this does not necessarily indicate that Pitocin caused this increased risk. More traumatic labor that requires more Pitocin administration might increase the risk for postpartum mood disorders.12
Related: Postpartum Depression: Symptoms, Causes, and How to Get Help
Alternatives to Pitocin
Depending on your risk factors and birth experience, there may be alternatives to routine Pitocin use after delivery.
Expectant Management
Expectant management means only intervening if necessary and allowing the body to naturally continue with the delivery of the placenta and clamping of the uterus. After birth, natural oxytocin surges to increase uterine contractions postpartum. Natural oxytocin is often more effective when there is less interference from induction, epidural use, other pharmaceutical pain management, or stress and anxiety. Therefore, many providers only recommend expectant management during low-intervention births.11
Uterine Massage
After delivery, your provider may massage and compress your uterus with one hand on your abdomen and the other inside your vagina. Studies have shown this technique significantly reduces blood loss in the hours immediately following delivery.4,13
Related: Uterine Massage After Birth
Breast Pump Stimulation
One study compared Pitocin administration with using a breast pump intermittently for 10-minute intervals during the third stage of labor. The breast pump was as effective as Pitocin administration at preventing or managing postpartum hemorrhage and did not affect pain or breastfeeding success.14
Other Pharmaceutical Interventions
Doctors sometimes use other medications to prevent and treat postpartum hemorrhage as a substitute for or in addition to Pitocin. These include Carboprost, Methylergonovine, and Misoprostol. All these medications work similarly, causing the uterus to contract and blood vessels to constrict. Most have similar side effects of nausea, vomiting, diarrhea, hypertension, fever, and shivering.4
Is Pitocin Required?
No. The American College of Obstetricians and Gynecologists, which informs standard medical care, recommends Pitocin; however, you always have a choice regarding your medical treatment.15 While several professional organizations recommend the routine administration of Pitocin to prevent postpartum hemorrhage, it is not mandatory, and you can opt out of it.
If you are at low risk for postpartum hemorrhage, you can talk to your provider about holding off on routine Pitocin. High-risk groups for postpartum hemorrhage include labor induction or augmentation, having a large baby, having an infection, or being obese. The use of Pitocin is strongly recommended for these individuals.15
If you show signs of postpartum hemorrhage, such as high heart rate, low blood pressure, nausea, chest pain, or low urine output, Pitocin is typically the first line of treatment to stop or slow your bleeding.17 Your doctor can continually reassess its use as your delivery and postpartum experience progress.
Pitocin is effective at preventing postpartum hemorrhage, but it may not be necessary for everyone. While it plays an important role in managing bleeding, it can also have side effects, and alternatives may be appropriate in certain low-risk situations. Talking with your healthcare provider about your options can help you make informed decisions that align with your birth preferences and medical needs.
